1. Local Solutions to National Change
Ken Eason
The Bayswater Institute
9 Orme Court
London W2 4RL
Emeritus Professor
Loughborough University

2. The NPfIT Strategy The aim
Shared electronic healthcare records across England in order to improve the co-ordination of healthcare delivery
The plan
Standard, inter-operable systems used by all Trusts delivered by a small number of consortia
The implementation
Roll-out across all Trusts in a 10 year period
Replacing existing systems
Trusts to pay local implementation costs

3. Implications for the Trusts
CfH
Suppliers
Diversity of Trusts
Type
Size
Healthcare Practices
Installed technical systems
Location

4. Problems as Trust’s assimilate NPfIT applications
Issue
Royal Marsden
Care Records will not support research
London Mental Health Trusts
Care records not fit for mental health - interim system needed
St. Mary, Sidcup
Slow system delaying patient care
Wirrell
New system means a step back in sharing records
Nuffield Orthopaedic
Out patient records lost
West Midlands
Smartcards not usable in A&E

5. Jonathan Michael ‘one size fits all’

6. Two local requirements
Recognising diversity
tailoring systems to meet local needs
Recognising it is a sociotechnical change and not just a technical change
developing local working practice to use the technology for better healthcare

7. A ‘local sociotechnical systems design’ strategy
Turning ‘push’ into ‘pull’
Treat IT implementation as a sociotechnical design process
The work practice implications are not fixed: local design opportunities
Exploit the flexibility of the technical systems for local customisation
Help local staff to:
identify specific benefits they can realise (develop a ‘pull’)
work out a local design plan to realise the local benefits/minimise the costs and risks
find an evolutionary path to achieve progressive exploitation of new technical capability
Eason K.D. (2005) ‘Exploiting the potential of the NPfIT: a local design approach’ BJHC&IM

8. Sociotechnical issues to address when implementing electronic healthcare records
Matching the records to the healthcare practice
Collecting data from patients at source
Including unstructured clinical data
Changing roles and responsibilities
Matching access rules to working practice
e.g. how to support team work?

9. Implementation Practices
What is needed?
Local Sociotechnical design
Focus on creating ‘transitional opportunities’ to experiment with new healthcare practices
Participation of all stakeholders
Evolutionary development of new ways of working
What is in place?
Change Management
Rapid ‘roll out’
Technical implementation
‘Good practice’ in electronic records usage
Limited support for the adoption of new working practices

10. Local sociotechnical design within the current programme
Some opportunities but:
Technical system constraints
Beliefs about ‘good practice’
Rapid implementation limits local design work
Focus on technical installation

11. National programmes and sociotechnical design: The way forward?
Technical design: ‘minimum critical specification’
Protocols for sharing data
Local organisations to select suppliers
Local ‘sociotechnical change’ teams to include
all stakeholders
Create opportunities for learning and experimentation
Recognise and support emergent behaviour and
evolution of new working practice